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Primäre Varikose

Primary varicosis

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Zusammenfassung

Die klassische Varizenoperation gilt noch heute als Goldstandard in der operativen Therapie der Varikose. Die Ergebnisse dieses Verfahren sind hinsichtlich der Komplikationen als sehr gut zu bewerten. Die Rezidivrate wird in der Literatur zwischen 6 und 60% in Abhängigkeit zum Nachuntersuchungszeitraum angegeben. Die wahre Rezidivrate ist jedoch unbekannt, da eine einheitliche Definition bislang fehlt. Die endovaskulären Verfahren zur Ausschaltung der Stammvenen – Radiofrequenzobliteration und Lasertherapie – haben sich als alternative, wenig invasive Verfahren mittlerweile etabliert. Bis zu 2 bzw. 5 Jahren postoperativ werden gute Ergebnisse publiziert, die denen der klassischen Varizenoperation vergleichbar sind. Der Vorteil der endovaskulären Verfahren scheint vor allem in der geringeren Invasivität und damit in der geringeren Beeinträchtigung der Lebensqualität im Vergleich zur klassischen Operation zu bestehen. Die Verbesserung der Lebensqualität von Patienten mit Varikose nach Operation ist aber auch für die klassische Varizenoperation bewiesen.

Die Bandbreite in der operativen Behandlung der Stamm- und Seitenastvarikose ist durch die neuen technischen Entwicklungen deutlich größer geworden. Für den Operateur bedeutet dies, dass der Patient gewissenhaft über die Vor- und Nachteile sowie die Ergebnisse der einzelnen Methoden aufgeklärt werden sollte und der Operateur sehr genau abwägen muss, welche Methode für den Patienten derzeit die beste darstellt.

Abstract

The classic varicose vein operation still represents the “gold standard” in the operative therapy of varicose veins. The results of this procedure in view of perioperative complications are very good, with the incidence of perioperative deep venous thrombosis varying between 0.05% and 0.1%. Recurrence rates between 6% and 60% are published. However, the true recurrence rate is unknown since an exact definition of recurrent varicosis is still lacking. In recurrent varices it is essential to distinguish between disease progression, including neorevascularisation, and technical errors. Endovascular procedures for elimination of the superficial venous system – radiofrequency obliteration and endovenous laser therapy – meanwhile have established themselves as alternative, minimally invasive procedures. The perioperative complication rate of endovenous procedures is very low and comparable to that of the classic operation. Good results, with occlusion rates of the treated vein around 87% to 93% up to 2 years postoperatively, have been published for both endovenous laser therapy and radiofrequency obliteration. For the latter, 5-year results were published, with occlusion of the treated vein in 87%. Results in the literature for radiofrequency are better documented than for endovenous laser treatment because there are now five prospective randomised trials for the former and most publications for endovenous laser treatment are single-center experiences. The advantage of endovenous procedures, especially radiofrequency obliteration, over the classic operation is the lower rate of perioperative pain and better quality of life. The spectrum of operative treatment methods of the superficial venous system has increased tremendously due to new technical developments. For the surgeon this implies the necessity of informing patients conscientiously about the pros and cons and available results of each procedure, and carefully weighing which methods are at the time best for the patient.

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  1. Zentrum für Gefäßmedizin, Obere Turnstraße 8–10, 90429, Nürnberg, Deutschland

    T. Noppeney, S. Rewerk, M. Winkler, H. Nüllen & H.C. Schmedt

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Noppeney, T., Rewerk, S., Winkler, M. et al. Primäre Varikose. Chirurg 78, 620–629 (2007). https://doi.org/10.1007/s00104-007-1366-9

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